51 research outputs found
Bone regeneration: current concepts and future directions
Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. However, there are complex clinical conditions in which bone regeneration is required in large quantity, such as for skeletal reconstruction of large bone defects created by trauma, infection, tumour resection and skeletal abnormalities, or cases in which the regenerative process is compromised, including avascular necrosis, atrophic non-unions and osteoporosis. Currently, there is a plethora of different strategies to augment the impaired or 'insufficient' bone-regeneration process, including the 'gold standard' autologous bone graft, free fibula vascularised graft, allograft implantation, and use of growth factors, osteoconductive scaffolds, osteoprogenitor cells and distraction osteogenesis. Improved 'local' strategies in terms of tissue engineering and gene therapy, or even 'systemic' enhancement of bone repair, are under intense investigation, in an effort to overcome the limitations of the current methods, to produce bone-graft substitutes with biomechanical properties that are as identical to normal bone as possible, to accelerate the overall regeneration process, or even to address systemic conditions, such as skeletal disorders and osteoporosis
Botulinum A toxin for treatment of lower limb spasticity in cerebral palsy - Gait analysis in 49 patients
Background: Injection of botulinum type A toxin is a new treatment for
spasticity.
Patients and methods: We evaluated the effect of botulinum A toxin
(BTX-A) in the lower limb muscles of patients having cerebral palsy. We
tested 49 patients before and, on average, 4 (2-9) months after giving
the toxin. The evaluation included 3-dimensional computerized gait
analysis, changes in mobility level, using the Gillette Functional
Assessment Questionnaire, and gastrocnemius muscle bulk, using
ultrasonographic measurements.
Results: The patients were divided into 3 groups, according to the site
of BTX-A administration (hamstrings, gastrocnemius and multilevel).
Those who were injected in the hamstrings showed a significant
improvement in only the maximum knee extension angle during the gait
cycle. Those with spastic equinus who were injected in the gastrocnemius
muscle responded better than the other groups. The ankle angle on the
initial contact, terminal stance and preswing, maximum dorsiflexion,
ankle range of motion, per cent of single support and gait velocity
improved significantly. Overall, the patients showed significant
improvements in motor skill performance and functional health.
Interpretation: Our findings indicate that botulinum type A toxin can be
given as an adjuvant to conservative treatment of patients with cerebral
palsy
Non-union of femoral neck fractures with osteonecrosis of the femoral head: treatment with combined free vascularized fibular grafting and subtrochanteric valgus osteotomy
Femoral neck fractures, frequently complicated by non-union and femoral
head osteonecrosis, present a difficult clinical situation, especially
when young patients are concerned. Existing treatment options are valgus
osteotomy to address the biomechanical factors or bone grafting to
address the biologic factor. The authors describe the operative
technique and results of combined subtrochanteric valgus osteotomy and
free vascularized fibular grafting in management of five young patients
with both non-union and avascular necrosis
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